Provider Demographics
NPI:1689893653
Name:CANDLER INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CANDLER INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:S
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-871-5000
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2029
Mailing Address - Country:US
Mailing Address - Phone:912-871-5000
Mailing Address - Fax:912-681-1444
Practice Address - Street 1:106 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2459
Practice Address - Country:US
Practice Address - Phone:912-871-5000
Practice Address - Fax:912-681-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3331Medicare ID - Type Unspecified